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Are colonoscopies worth it?
- deleted 3y ago[deleted]
- EgregiousCube 3y agoYou mean I get scoped every few years and it’s not even a thing??!
- csours 3y agoThe problem with medical interventions, especially tests, is that they sometimes work. There will always be success stories. The big question is: are those success stories worth it, and are there other paths to those same success stories.
- haldujai 3y ago> The problem with medical interventions, especially tests, is that they sometimes work. There will always be success stories. Do you prefer medical interventions that never work? > are there other paths to those same success stories. Yes, in the US other options include high sensitivity FOBT, FIT, sDNA-FIT and CT colonography.
- Vecr 3y agoCT as in X-ray computed tomography? If so, it's dubious if that's safer than a colonoscopy, depending on what ionizing radiation harm model you use.
- denton-scratch 3y agoFor my procedures, they used a continuous X-ray to monitor the location of the equipment. I'm pretty sure I was more irradiated than by a CT scan.
- haldujai 3y agoWe are required to use LNT in the United States and Canada. The attributable cancer risk for CT colonography is a rounding error, and considerably lower than the quoted perforation risk. That said as a radiologist I personally still opt for colonoscopy screening, it is however an option for patients.
- rocqua 3y agoI think the original sentence was meant more like 'the problem with unproductive tests is...' Where unproductive means that the total cost benefit of doing the test is negative. And even procedures that never help can 'cure' people just by regression to the mean.
- csours 3y ago> Do you prefer medical interventions that never work? Are there medical interventions that never work - aside from bad faith hypotheticals? Even placebo works pretty often. The article under discussion is all about teasing apart confusing and conflicting data in medical studies. The comment I replied to asks why they have been directed to do something useless. >> are there other paths to those same success stories. > Yes, in the US other options include high sensitivity FOBT, FIT, sDNA-FIT and CT colonography. Statistically, yes - but individual humans don't really think in statistics, we think in stories. My buddy won big at the casino, maybe I will too. I'm sure my dear fellows on this website will never be so stupid as to be motivated by a story about winning at a casino, but it is very EXPENSIVE to apply this level of rational rigor to every part of your life.
- haldujai 3y agoI don’t understand what you mean by statistically? All of those are endorsed by the USPSTF I.e. reimbursed by insurance and available in the US.
- nirav72 3y agoDont think its suppose to be every few years. I was told it’s good for 10 years. Unless you are in high risk category. Specifically one with a family history of colon cancer. That’s what I was told when I got one as soon as I turned 50. I don’t have to get another one until I’m closer to 60.
- LarsDu88 3y agoColonoscopies come with potential for complications. There are actually a number of companies which have either released or plan to release non-invasive colorectal cancer screening based on blood dna sequencing. GRAIL, Freenome, and Guardant all have tests out or coming down the pipeline.
- jay_kyburz 3y agoI got a letter from the government last year saying they wanted some of my poo, so I sent them some. The whole thing was weird, but much better than visiting a doctor. I'm in Australia.
- huytersd 3y agoThey have your DNA now.
- chrisweekly 3y agoColonoscopies also have a big advantage in that while the doctors are in there, if they see anything forming that is pre-cancerous they can take it out before it turns into a problem that would show up on a blood test. * props to @nwellinghof whose response I stole and adapted
- pasc1878 3y agoWhich is why after another screening method sees something you are offered a colonoscopy to look further and if early enough do a simple removal which is much less of a risk and has less side effects than a full operation to remove parts of the bowel.
- haldujai 3y agoSure but procedural complications are actually quite rare, as alluded to in this article. Misses from operator error, suboptimal bowel prep, or inability to complete the examination are more common and where we have the most potential for benefit from novel screening tests.
- andsoitis 3y agoAs far as I know, countries outside the USA that recommend it are Switzerland, Germany, and Austria: https://publichealthreviews.biomedcentral.com/articles/10.1186/s40985-018-0080-0 https://publichealthreviews.biomedcentral.com/articles/10.11...
- OfSanguineFire 3y agoI was going to post the same thing – Poland launched a nationwide campaign two years ago to get all people over 50 years old (above 40 if they had family history) in for a colonoscopy. However, the linked article is working with a European study done a decade ago (EDIT: I’m wrong about that). There may have once been greater differences between American and European approaches.
- ekianjo 3y agoData does not seem to indicate better survival odds so whats the point?
- hackandthink 3y agoThere would be an reduction of 37% in diagnoses if everyone would have accepted the treatment (but no data for mortality). How significant is reducing a small risk (1%) significantly? (Base rate fallacy) "The right graph compares those results to the observed outcomes for acceptors in our branch of the multiverse, where they did have colonoscopies. At the end of the trial, there’s a reduction of 37%. Unfortunately, data aren’t available to do this for mortality,..."
- hackandthink 3y agohttps://asteriskmag.com/media/pages/issues/04/you-re-invited-to-a-colonoscopy/31771328c9-1696013432/dynomight01b.svg https://asteriskmag.com/media/pages/issues/04/you-re-invited... Actually I am confused by this graph (right side): 1% of refusers are diagnosed with CRC versus 1.4% of would be acceptors would be diagnosed with CRC. So refusing is better than accepting. I guess I am missing something.
- refurb 3y agoThis is actually a nice summary of how a clinical trial is more than just "did it have a positive or negative result?". Every single trial introduces some bias through the way it's designed. Good trials try to minimize bias or at least limit it to things we know don't introduce bias. The article does a nice job at digging into the nuances of the trial design and how it may influence (or not influence) the results. That's why the "reference wars" you see on HN are so pointless. It's easy to just find a paper that supports your position. But trials are of varying quality. What you see in this article is what normally happens with most major trials - results get discussed, challenged, discussed some more. After a few months doctors finally settle on the main takeaways. Sometimes it takes years.
- re 3y agoYeah, I thought the discussion of how you couldn't just directly compare people that accepted the colonoscopy invitation with the control group was really interesting, and non-obvious (at least to people like me that don't design studies). It reminds me of the fundamental problem that all surveys have in terms of the bias introduced by being limited to "people who agree to take surveys".
- Nevermark 3y agoAny self-selection where higher risk individuals opt-in more, increases benefit/cost ratios. That seems like a pro invitation argument. (I.e. pro treatment for the invited + opt-in cohort.)
- rocqua 3y agoBut alternative screenings with a wider acceptance could have a higher 'benefit-cost' for a lower 'benefit/cost'.
- cloudyq 3y ago[dead]
- tedunangst 3y agoArticle doesn't actually answer the question? Certainly interesting information about the topic and efficacy, but it doesn't really explain how the current situation came about. Why is my neighbor driving around on a donut? I could write 3000 words on the history of tires, the assorted trade offs of trunk storage vs spare diameter, the geographical distribution of potholes, etc., but none of that explains why the donut is there.
- plugin-baby 3y ago> Why is my neighbor driving around on a donut? Complications from a colonoscopy?
- deleted 3y ago[deleted]
- smnrchrds 3y agoI was satisfied with the answer given in the Discussion section at the end of the article.
- tedunangst 3y agoOkay, thanks, went back and read it again. I may have preferred more, but it is there.
- crossroadsguy 3y agoIf someone else hasn't clicked on the article link (people still do that?) it says literally this: Are colonoscopies better than other screening methods? I don’t know. Maybe!
- eastern 3y agoThe sad thing about the article is that skirts around mentioning the possibility that the American disease industry hates this trial because it will reduce their income. The good thing about the article is that it has a colonoscopy joke that also involves (bonus for the HN crowd) Bayesians.
- labster 3y agoDid you read the whole article? It definitely mentions cost and financial interest in the discussion section.
- IcyWindows 3y agoIt didn't mention the bias from those that don't want to pay for the procedure which was a little unbalanced, perhaps.
- eastern 3y agoDid you read my comment? I'm saying that the Americans want colonoscopies to remain unchallenged because they make money out of it. This has little (or nothing) to do with the cost-benefit trade-off that the article discusses. I didn't find this (self-evident) idea anywhere in the article.
- Tabular-Iceberg 3y agoIsn't asking people if they read the article frowned upon here on HN?
- joshuaheard 3y agoMy doctor recommended Cologuard, a test of your stool sample for cancerous DNA, instead of a colonoscopy. I can't imagine taking a colonoscopy now.
- nwellinghoff 3y agoColonoscopy has a big advantage in that they are already in there. If they see anything forming that is pre-cancerous they can take it out before it turns into a problem that would show up on a Cologuard test.
- gcheong 3y agoBut that’s also highly dependent on how good the doctor is at finding the problems. Apparently doctors in the US find precancerous polyps 40% of the time according to the article. That may not be so great given the time between screenings (ten years) if one is missed.
- iaseiadit 3y agoIt’s great if you’re in the 40%.
- raverbashing 3y agoAnd the big disadvantage that to get there your need to book 2 professionals (?) and take pretty much one day off, and there are risks associated with anesthesia and the procedure itself I don't think it scales (Not to mention the interests of doctors of suggesting things that make them more money) Edit: now I see TFA mentions risk of perforation and that the risk is smaller without anesthesia
- ghaff 3y agoWell, in the US, they're following normal protocol. It would probably be irresponsible for them to try to dissuade you from a colonoscopy. But, yes, it's a day involving a gastroenterologist, typically an anesthesiologist, nurses presumably, and someone to take to back and forth from the procedure. It's definitely not standard lab work.
- deleted 3y ago[deleted]
- shoelessone 3y agoI have no first hand knowledge of this but I've heard that colonoscopies are very common in S. Korea, even starting at younger ages. Can anybody comment on this?
- huytersd 3y agoI have heard they have a massive drinking culture without the genes to handle it so stomach and colon cancers show up a lot.
- MrDresden 3y agoI don't think genetics really play any part in handling alcohol's part in the forming of cancer. If it did then Finland shouldn't really have the incident rates of alcohol caused cancers as they do. The same probably goes for other nations where heavy alcohol consumption has been a norm for centuries. Alcohol causes cancer, and there is no intake amount that is beneficial to the body.
- abigail95 3y agoI don't know any gastroenterologist over 40 that hasn't had one (Australia). Do I take the government advice or copy what the doctors themselves are doing?
- Barrin92 3y agoThis is a large, randomized control trial, so obviously you should value this significantly higher than whatever doctors are doing to themselves. (history has more than a few examples of doctors practicing medicine that didn't make a whole lot of sense).
- woleium 3y agoIf only Semmelweis wasn’t such a strange chap, we’d have been much more further forward now.
- all2 3y agoI don't know what this means. Can you expand on your statement? Who is this person? What would we be farther forward to?
- woleium 3y agohttps://en.m.wikipedia.org/wiki/Ignaz_Semmelweis https://en.m.wikipedia.org/wiki/Ignaz_Semmelweis He had very sensible ideas about hand washing a hundred years before it was accepted by most doctors. He was a bit weird though, and ended up being ignored.
- fodkodrasz 3y agoWeird as in saying the common practices are not correct, and here is my proposal for a better practice, as supported by statistics.
- touisteur 3y ago
- irrational 3y agoMy brother had stage 3b colon cancer caught by a colonoscopy. He was treated and is still alive, so… that seems pretty good to me. My company health plan recently announced that starting next year you can get a free Colonoscopy every year.
- methou 3y agoMy uncle had one, it almost killed him when the probe breached his colon causing an internal bleeding. It was done with anesthesia, which according to him could be a major contributor to the incident.
- gumby 3y ago> It was done with anesthesia, which according to him could be a major contributor to the incident. The article suggests his reasoning could be well founded.
- silisili 3y agoThis is actually what killed my grandmother back in the 80s, for the same reason. I'd hoped they'd be safer by now...
- vultour 3y agoDo any countries apart from US routinely do it under general anaesthesia? I don’t know anyone who was under during the procedure.
- modec 3y agoIn Denmark, when you turn 50 you start sending in a stool sample every other year. If it works, I think I like that model better.
- bluGill 3y agoMy mother in law had a negative stool sample and died of colon cancer 9 months later.
- yencabulator 3y agoAnd colonoscopies miss 60% of the precancerous polyps. There's no such thing as a guarantee in healthcare. > The skill of a doctor doing a colonoscopy is often measured by their adenoma detection rate — how often they find a precancerous polyp. American doctors find them 40% of the time.
- Reasoning 3y agoCan we stop referring to Europe as "the rest of the world"?
- croes 3y agoColonoscopies are pretty common in some european countries, so I don't think most of the world means Europe.
- atlgator 3y agoMy father died of colon cancer at 52, so I've been getting colonoscopies every 3-5 years since I was 22. Yes, that's really early, but in the span between age 30-33, I grew a large polyp. My doctor removed it and it turned out non-cancerous, but if I waited until 40+ to start who knows?
- dehrmann 3y agoThe article theorized that some of the acceptors in the study likely looked at their family history when making the decision. They might not be especially helpful on average, but because of your father, they're much more helpful for you.
- glenstein 3y agoOne thing I'm having trouble parsing from the study relates to exactly the point you're raising. If it's assessed as like a national program applied to everyone, that's one way of understanding its value. But if you believe yourself to be a part of a special at risk population and can have good reason for making that determination, to me it raises a new question about the wisdom of proceeding.
- bumbledraven 3y agoIn The Value of Colon Cancer Screening (https://www.blackliszt.com/2023/01/value-of-colon-cancer-screening.html https://www.blackliszt.com/2023/01/value-of-colon-cancer-scr...), David B. Black argues that colonoscopies are a net negative, based on the “high confidence result of harm based on millions of patients [1], vs. the nearly identical low-confidence results of benefit from the NordiCC study”. [1] “14.6 major bleeding events per 10,000 colonoscopies (95% CI, 9.4-19.9; 20 studies; n = 5,172,508) and 3.1 perforations per 10,000 colonoscopies (95% CI, 2.3-4.0; 26 studies; n = 5,272,600)”
- sillysaurusx 3y agoIt’s time to share something personal again. When I was 20, I vividly remember being in the bathroom at my workplace when a large amount of blood started coming out. I did what any smart, effective 20yo would do: ignored it because I was embarrassed. Fast forward 10 years, and I’d been ignoring it for a decade. It had continued to happen every few months. Sometimes the blood was so bad I’d have to wait up to 20 minutes for it to stop. Other times I would see blood, but no bleeding. These are bad signs. If you see this, don’t do what I did. I was gambling with my life. Remember that popular video game commenter that died from this? Totalbiscuit? He concealed his, and he lost. The most unexpected thing is that when I actually wanted one, the process took over two years. And that was after a year or so of periodically mentioning it to the doctors, who would give me a sheet of numbers to call and I never bothered. Those three years could have been the difference. Turns out, there’s nothing wrong with me. It was hemorrhoids. You might think you’re smart enough to tell the difference. I thought so. I was a cocky idiot who could’ve died from cancer before seeing my daughter get married. Just get one if you see something. The final paragraph of the article pleads you to. The peace of mind alone was worth the small unpleasantness and major logistical annoyance.
- ChrisCinelli 3y agoIf it is RED blood, it is a vein that breaks when the your stool passes. Most likely hemorrhoids. The problem is when you have BLACK blood in the stool. That may be an internal bleeding.
- rocqua 3y agoRed blood consistently still deserves to be checked out.
- conductr 3y agoI had a misdiagnosed anal fissure for a year. Get the ass doctor involved early, my GP was clueless about it and had me trying hemorrhoid/lidocaine creams for a year while in agonizing pain. The first thing the ass doctor asked was; do you know what a fissure is? before the exam even started. I learned to skip past the general doctors to the specialist from this experience. Also, the anus is the fulcrum of your body, treat it well.
- deleted 3y ago[deleted]
- hackandthink 3y agoThis is about people between 55 and 64 years old at the start of the study. After 10 years: The risk of getting colorectal cancer is about 1%. The risk of dying because of colorectal cancer is about 0.3%. Getting an invitation the study does not change much. Actually getting a colonoscopy helps more (37% reduction in getting the cancer, no data for dying).
- kuboble 3y agoIf you read the article thoroughly it explains exactly why your reasoning is incorrect. Tldr; comparing control group to acceptors group is not right because who accepts and who doesn't isn't random. We don't know the exact bias introduced but the author theorizes that people who are at higher risk are more likely to accept the invitation(e.g. someone with a colon cancer in family, someone having weird feeling about her tubed as the article calls it., etc.)
- deleted 3y ago[deleted]
- bluGill 3y agoYou are both right. The study at only 10 years didn't run long enough for us to expect to see much. That is one reason medical studies are hard, we are often interested in changes we could make today that won't matter for decades.
- russellbeattie 3y agoI had an abdominal MRI done a few years ago to look for intestinal issues, and was surprised at the resolution. Ever since I've wondered why we don't just do that regularly to see if there's anything that looks worrisome, before going through such an invasive process as a colonoscopy. Actually, I just looked it up. Apparently it's a thing and called "virtual colonoscopy" [1]. Seems like the future to me. 1. https://www.mayoclinic.org/tests-procedures/virtual-colonoscopy/about/pac-20385156 https://www.mayoclinic.org/tests-procedures/virtual-colonosc...
- rocqua 3y agoMRI machines are much more expensive than colonoscopy machines. Orders of magnitude more expensive.
- kwhitefoot 3y agoBut the MRI machine can do a more thorough investigation is less time with less inconvenience to the patient and with fewer medical staff. The colonoscopy I had essentially occupied a doctor and a nurse for close to half an hour. The MRI that I had more recently for the same purpose took one radiologist and the part involving me was over in less than fifteen minutes. And the capital cost of the machine is not necessarily the relevant measure. If the MRI machine is idle then it is wasting money so if you have one it should be used as much as possible which means that the marginal cost of the MRI might well compete with colonoscopy. I have also read that many colonoscopy patients, especially in the US, require sedation which of course is not necessary with MRI.
- szeretlk 3y ago[flagged]
- Expez 3y agoThe article doesn't cover this, but it's worth pointing out why the study asks this particular question. With a single-payer system the Nordic countries want to know what the ROI is if we sent letters out to everyone above a certain age offering a free colonoscopy. The study is well-designed to answer that question. The study does a poor job of helping an individual asking a similar but different question: Is it worthwhile for me to pay out of pocket for a colonoscopy? The latter question is very important in a system that isn't single-payer and so this has sparked a lot of debate in e.g the US.
- kashunstva 3y agoThe intention-to-screen design of the trial depends heavily on the effectiveness of recruitment and the pre-existing “prevalence” of the test in the setting in which the study is conducted. I can see rejecting an unpleasant, rarely used screening test. But if it were presented in a less impersonal (but still unbiased) way, I imagine recruitment would have been higher, skewing the data towards cost-effectiveness, as re-analyses showed.
- credit_guy 3y agoI did a colonoscopy last year, and it was covered by my insurance (in the US). I was referred by my primary care physician. My insurance is nothing special, it's the standard type of insurance people have access to when they get a corporate job. The type of question "are colonoscopies worth it" is not actually people should ask themselves. This is a question your primary care physician should answer, and you should follow their advice. If you don't trust them, just go find another one.
- BrandoElFollito 3y agoThis is very common in France. I think all my 50+ acquitances had one. There is a national screening campaign based on sending a sample of your stool, but getting a colonoscopy is a matter of asking your doctor. It is true that colonoscopy is not the first mine of prevention but anyone who asks will get one. Free of charge.
- pasc1878 3y agoThis is also they way in the UK. A large screen of everyone over 60 via stool sample. Then ONLY if that shows issues then a CT scan and then a colonoscopy.
- BrandoElFollito 3y agoIn France you can ask for a colonoscopy and your MD will order it (and if they are reluctant or want to have a string reason you just say that there is family history).
- pfannkuchen 3y agoBecause it was colon-ized?
- PeterStuer 3y agoHere a colonoscopy is adviced by my doctor for anyone aged 50. She told me the free screening kits for bowel cancer the government sends out is mostly an awareness campaign as those tests are extremely unreliable.
- bluGill 3y agoThose kits if run every few years (not sure which they are running, different kits have different schedules) are pretty good and a lot cheaper than colonoscopies every ten. In single payer systems cost effective matters differently and so they may choose to use them instead. You can debate if they have the correct numbers when.counting cost effective.
- s1artibartfast 3y agoPeople struggle with binaries. It is very likely that regular colonoscopies are net harmful for most people, and very beneficial for some. The population isnt homogeneous. Some people have significant risk factors, like family history, others do not. We don't ask if everyone should start wearing glasses at 40, so why this?
- kqr2 3y agoBut people with healthcare / vision care usually have their eyes checked yearly.
- s1artibartfast 3y agoYes, but eye exams don’t carry a risk of death. It is a noninterventional screening. It is more like a stool sample or questionnaire than a colonoscopy
- dgellow 3y agoGiven people don’t read the full article, and that feels pretty important in this discussion, I will quote the way it ends: > One thing is clear: Screening works. If you’re of the appropriate age, please get screened. If your tubes are acting funny, please get screened without delay. The best method and the level of benefit are debatable, but we know it helps. Use a stool test if you want (multitarget DNA test if you can), or a colonoscopy, or a sigmoidoscopy, or a “virtual” CT colonoscopy, or a crazy edible camera. Do one of them. Statistics show colorectal cancer is highly curable when caught early, and now that we have feisty checkpoint inhibitor immunotherapies,it’s probably even better now. Just do it. Your tubes will thank you.
- timr 3y ago> One thing is clear: Screening works. If you’re of the appropriate age, please get screened. If your tubes are acting funny, please get screened without delay. The best method and the level of benefit are debatable, but we know it helps. That's unfortunate, because it's a poor summary of the actual paper the article is discussing. If you bother to read the rest of the article, you'll see the actual summary of the trial, and it's pretty darned easy to interpret for yourself: https://asteriskmag.com/media/pages/issues/04/you-re-invited-to-a-colonoscopy/426b760313-1696013385/dynomight_temp01.png https://asteriskmag.com/media/pages/issues/04/you-re-invited... to wit: > The 18% reduction in colorectal cancer incidence was statistically significant, while the 10% reduction in colorectal cancer mortality and 1% reduction in overall mortality were not. (Those reductions are relative risks, which are on very small baseline numbers.) Then the article goes on for many pages about how American gastroenterologists do not agree...which isn't terribly shocking, considering the source of the argument. But a number of rebuttals are made, some of which are reasonable (i.e. colonoscopies are one of the few screening tests to actually do something to prevent disease, in the form of clipping polyps), and others of which are quite simply lies ("other studies have estimated larger benefits for colonoscopies" -- yeah, but those studies were bad, and this one was good, which is why we're talking about it!) Note that American gastroenterologists do a lot of colonoscopies, mostly without good evidence. This was the first major RCT in decades to consider the question at all. The other screening methods have even worse evidence, and certainly no good evidence at the young ages we do them in the USA (currently 40 in men; the studies are all in much older age groups). Overall, the NORDICC trial paints an incredibly ambiguous picture for the effectiveness of colonoscopy at preventing severe illness or death -- at the very least, the benefits are likely dramatically overstated. Discussing all of this, then turning around and claiming "it works" is an insult to evidence-based medicine. (FWIW, I'm personally torn on the meaning of the study. I just think that "one thing is clear" line is a particularly odious bit of "journalism" -- not the least because it confuses symptom-free screening with doing something in reaction to symptoms. The rest of the article is pretty fair, IMO, but that line is substituting the opinion of the author for an actual summary of the data.)
- deleted 3y ago[deleted]
- surfsvammel 3y agoPeople here talking about you deciding whether or not you got cancer from the colour of your stool. Here is another piece of medical advice: If you have blood in your stool, see a doctor. Period.
- surfsvammel 3y agoI do regular colonoscopies because of a condition. People are worried about the procedure, as I was my first times. Here are some things that I wish someone had told me: - Taking the meds for cleaning out your system the day before is far worse than the procedure itself. - Have a lollipop to stick in your mouth after Each time you take a shot of the laxatives. It helps with the vile taste of it. - If you need relaxing meds or something for the pain and discomfort, they have good stuff handy when doing the procedure. - It only ever hurts if your colon are in bad shape. Colonoscopy doesn’t hurt if you are healthy (and even if it does, they have meds for the pain). - Don’t be embarrassed, the hospital staff do this all the time. They don’t really care about the things you are worried that they might care about. - Wear loose fitting clothes that are easy to change in and out of when you go to the hospital. - Try to relax.
- danw1979 3y ago> It only ever hurts if your colon are in bad shape. Colonoscopy doesn’t hurt if you are healthy (and even if it does, they have meds for the pain). I’m sure there will be a few people popping up to disagree with this and I think you kind of disagreed with yourself in that sentence anyway. I got the all-clear in the end, and my guts are not in bad shape (don’t drink much, never smoked, eat healthy), and I’ve generally got a high pain threshold… but the procedure (only a flexi-sigmoidoscopy) hurt like hell and I wish I’d had some form of pain control beforehand.
- spondylosaurus 3y ago> It only ever hurts if your colon are in bad shape. Colonoscopy doesn’t hurt if you are healthy (and even if it does, they have meds for the pain). Ha, the procedure itself was painless for me since I was out cold, but during the prep I distinctly remember thinking (between waves of cramps) "Damn, maybe I do have Crohn's..."
- XorNot 3y agoWas a total breeze for me for the same reason, except I felt great right before it because apparently one way to get IBS relief is to have nothing in your bowels at all.
- Findecanor 3y agoI have a genetic predisposition for colon cancer, and have had nine colonoscopies: one every one–two years. As others have said: if your colon is otherwise healthy, it is safe and the worst part is the prep. However, the last time 10 months ago, my body's immune system was stressed by another cancer, and so a tumour developed in only nine months. Because of the risk of more colon cancer during the treatment of the other cancer, the doctors removed my colon, despite it otherwise being "strong, young and healthy". I now poop fluids in a bag glued to my belly: it is better than being dead, but something you'd definitely want to avoid. I actually miss colonoscopies now. I always watched the screens: it was beautiful and fascinating.
- hermitcrab 3y ago>I always watched the screens: it was beautiful and fascinating. It is a weird experience. The ultimate form of introspection!
- hermitcrab 3y ago>3. It’s irresponsible to call colonoscopies “invasive” (as CNN did) since that might make people think they are unpleasant and not do them. LOL. It hard to imagine anything much more invasive than having a metal tube (with light and camera) shoved up your arse. It is definitely unpleasant. I speak from personal experience. That said, it is less unpleasant than bowel cancer. So don't be put off if you really need to get it done. It's not that bad.
- ramraj07 3y agoIt is invasive, as are most gynecological procedures. It sounds disingenuous to try and sugar coat this. My female acquaintances have long been lamenting the trauma of gynecologists especially in India telling them “please get a scan in the next room it’s a simple procedure” only to get a probing that’s not just invasive but even painful at times.
- matheusmoreira 3y agoYeah. It's definitely a simple procedure... To the doctors who do it all day every single day for decades. To the patient who's going to be examined, it's extremely invasive.
- dkarras 3y agoI have not had one but closely monitored people that had a colonoscopy. The prep looks like worse than the colonoscopy itself.
- dean177 3y ago>3. It’s irresponsible to call colonoscopies “invasive” (as CNN did) since that might make people think they are unpleasant and not do them. They are invasive, they are also unpleasant. It isn’t irresponsible to say those things it’s just true.
- cfn 3y agoI see several personal accounts and I could also share mine but given that colonoscopies "rarely — but not that rarely — have serious side effects" and that there was only an overall 1% difference of all cause mortality between the groups in the trial, is it worth risking the side effects if you are healthy and don't have any symptoms?
- fjfaase 3y agoThe side effects are only mentioned in the first paragraph of the article. I wonder how many people have died (or suffered considerable and possible lasting harm) as a result of colonoscopies performed during the period of the investigation and who were otherwise healthy.
- deleted 3y ago[deleted]
- theogravity 3y agoI just got one two days ago because my family has a history of it. Other than having to go on a no fiber diet and ingesting specific sets of salts to empty the bowel for the procedure, it was pretty in and out, and no pain at all afterwords (probably because they didn't find any polyps). I went home with neat pictures of my clean colon. Also lost 10 lbs in the past week but already seemed to have gained back a little in the past two days from eating normally again.
- denton-scratch 3y ago> (probably because they didn't find any polyps) They found polyps in mine, and removed them; no pain after. The colon doesn't have pain nerves.
- theogravity 3y agoThat's good to hear they found and removed them before it can become a bigger problem. Does that mean you have to do a visit every 2-3 years now?
- tomohawk 3y agoA family member was going to get screened, and the insurer would only pay for a sigmoidoscopy since there were no indications of any issues. He paid for the full deal, and they found cancer they would not have found otherwise. He paid because a coworker had died due to undetected cancer - undetected because they didn't do the whole colon. A paper may talk about percentages, but that doesn't represent you - it represents what an insurer or provider might find interesting to lower costs. You either have cancer or you don't. If you want to find out, you need to check.
- ChrisMarshallNY 3y agoI have a friend that avoided it for most of his life. When he finally got one (in his late fifties), it showed stage IV colorectal cancer. He went through seven months of channeling Uncle Fester, but seems almost completely back to normal, now. He is much more into taking care of himself, these days.
- thanatos519 3y agoNevermind the prep, the embarrassment, and the physical discomfort. It was totally worth it because I got to watch it live on a big screen TV! I had a heart catheterization recently. No prep, no embarassment, and only a bit painful where it went in at the wrist and bent at my elbow. Also super cool to watch!
- deleted 3y ago[deleted]
- collinstevens 3y agoIf you're worried about getting a colonoscopy, don't be. I got one last year and it was the best sleep I ever got. It was two days of the prep stuff you drink to shit your brains out which is a little rough, but I have a bidet, no big deal. Then you go to the hospital, you dress down into a gown, nurses come in, they put some things on your chest, you get a little cold, they put a nice warm blanket on you, they start an IV, they wheel you into the procedure room, and then you pass out. You suddenly wake up and I felt like I had an amazing nap and I was incredibly comfortable. Then you have someone drive you home and that's all there is to it. It was really no big deal. The only thing that sucks is you pretty much just drink powerade and eat chicken broth during the prep.
- deleted 3y ago[deleted]
- Zanfa 3y agoHonestly, even without any anesthesia or sedatives, the worst part is drinking the laxative for prep. If you can sit through a visit to a dentist, you can likely handle the procedure itself without any meds. I was actually surprised they even do general anesthesia for it in the US.
- balfirevic 3y ago> If you can sit through a visit to a dentist Do you mean with local anesthetics?
- Zanfa 3y agoYes, dentist with local anesthesia is worse than a colonoscopy without meds.
- denton-scratch 3y agoThat's not my experience. Dental local anaesthesia has improved hugely since I ws a kid; the only really unpleasant dental procedure I've had recently was a root-canal. Routine filling replacements were uncomfortable, but painless, and much quicker than a colonoscopy.
- mft_ 3y agoThere's an interesting point made in a podcast (Huberman, perhaps) - which is that Colon Cancer could be totally eliminated as a cause of death, if we used screening via colonoscopy optimally. As in, play a thought experiment: * First, imagine everyone in the world gets a colonoscopy every day --> obviously, all cancers would be picked up, but this is infeasible for some reasons (e.g. cost, economic impact) and suboptimal for others (e.g. iatrogenic harm, human cost). * So, using data, apply colonoscopies more sparingly, based on risk factors such as age, genetics, family history --> if this is done right you'd be able to pick up every colon cancer in its very early stages, either at a pre-cancerous stage, or an entirely curable stage.
- oarfish 3y ago> colonoscopy every day --> obviously, all cancers would be picked up Would be the first medical test with 100% sensitivity probably?
- fulafel 3y agoWould detecting all cancer cells there be useful? The immune system being the first line of defense.
- drowsspa 3y agoWhat's the prevalence of colon cancer within the general population? Per Bayes' rule, I doubt it's enough to decrease the level of false positives to an acceptable level.
- bluGill 3y agoSince you can't eat for a day before, colonoscopies daily would also prevent death by heart attack as everyone would starve to death in a couple months.
- JoeAltmaier 3y agoJust stopped eating three days before. Forget the drugs and liquids. Took no anesthetic for the procedure. Not really bad; just embarrassing, get over yourself. Drove myself home ten minutes after. No problems. Have to be good with fasting. Mostly it's a matter of habit, remembering not to graze in the evening. I don't feel hunger as a big deal; your mileage may vary.
- Tabular-Iceberg 3y agoWhen a friend of mine had one he told the staff "too bad I'm not gay or I would have enjoyed this". Which made me wonder if any research had been done on how many times per day doctors and nurses administering colonoscopies have to hear this line.
- bjornsing 3y ago> When setting recommendations, the U.S. Preventative Service Task Force explicitly does not consider costs. This is a great summary of the difference between US and European preventive medicine.
- tonnydourado 3y agoI'm still flabbergasted that anyone in the face of the planet even considers doing a colonoscopy without sedation.
- rexpress 3y agoI had it done twice, both times without sedation by choice. I did have analgesics, and a cannula in my wrist in case I changed my mind mid-way. It was quite tolerable, just a few moments of short lived cramping pains (similar to diarrhea pains) as the endoscope turned the corners of my insides. My recovery was about half an hour of sitting up and having tea and toast, while those that were sedated slept off the drugs. I'd do the same again if ever I get another one, and recommend it to anyone who can't have or doesn't want sedation.
- downut 3y agoHere's another me too. When I turned 55 my GP started to nag me to get a colonoscopy, and my wife too. But in the small western town that we lived, there's only a very small number of specialists and for 1.5 years "they" kept accusing us of not submitting the paper work. (We did, each time). It all sounded unpleasant and I was riding fast times in centuries so how bad could it be? Finally the GP needed a colonoscopy and the specialists did to her what they did to us and she got pissed off and forced the issue. And her nagging was effective and got us through the procedure. My wife was fine. I was Stage IIa. I did not get the IIa diagnosis until after 10+ weeks, including 4 weeks after the 18" resection. Only thing anyone would say is "your diagnosis is unknown, could be Stage 4". Which, you know, kinda sucks, and I can tell you it might suck harder for your life partner, than yourself. You'll be gone, and they go on alone. So I get (used to get) colonoscopies every six months and the very good surgeon down in Phoenix chops out the polyps. Weirdly he can fit me in on a couple of weeks notice. But COVID fucked all that up. And then we moved across the country. So now I'm starting all over with the fact that we can't find anyone local to do the colonoscopies. But it MUST GET DONE. (Reminding myself). So yes indeed it's annoying but if you've got cramps or occasional blood in the stool or are over 55 and never had one do not avoid the colonoscopy. Everyone who loves you will appreciate it. BTW I started riding centuries again about six months later and the next year I set my life record in the Tour de Tuscon. I tell people the resection was my weight loss plan. I get weird looks. I enjoy it.
- refracture 3y agoI had to fight with my doctors as a late 20-something to get one. Polyps, the Doctor who performed it told me he was proud of me for being persistent and made it clear that colon cancer is not an old man’s disease anymore. I knew this because my brothers best friend died at 30 from it.
- proee 3y agoWhat about swallowing a pill camera? Could these be a slightly less invasive way to screen your colon? The technology for pill cameras along with AI should keep improving.
- greedo 3y agoOne benefit of a "proper" colonoscopy is that the scope has a little wire that's used to remove polyps. Polyps have a high chance to progress to tumors, so nipping them in the bud is a good idea. Can't do that with a pill camera setup.
- deleted 3y ago[deleted]
- greedo 3y agoSo here's my story... Age 39. Presented to family GP with rectal bleeding. He did no exam, pretty much dismissed it as a hemorrhoid. Age 40. Complained again to GP that bleeding was continuing (sporadically). GP finally decides to refer me to the local thoracic surgeon. This surgeon gives me a go over with an anoscope and schedules a colonoscopy the next day. Turns out I had a 5cm tumor... I was married with two very small kids. Not the best time to get cancer. A week later I'm starting radiation therapy to try and shrink the tumor. A week or so after that (things tend to blur when medicine moves fast), I'm started on chemotherapy treatments. I start to lose weight (I was 6'2"/240lb at the start of this). I get a portacath above my heart so chemo drugs can go straight into a big vein. I carry a pump around to push my chemo drugs in on a reliable schedule. This combined treatment goes on for a month before I go through surgery. I'm experiencing neuropathy from the oxaliplatin, which makes your extremities very sensitive to the cold (and of course I live where you have real winters). Foods taste wrong too. Go in for surgery and come out with an ostomy. The surgeon had tried to save enough stuff so I didn't need a bag, but well, sometimes biology has other ideas. The tumor was too large and too close to all the rectal muscles. At least the surgeon said there were good margins, and no signs of metastasizing. So now I have a bag. At this point I way about 160lbs. Nothing tastes good except candy, and the docs are worried about my weight loss. So I get the green light to eat as much candy as I want. Now I'm alive, with a bag, but alive. I'm taking some experimental oral post-surgical chemo pill 4x daily to try and kill any little bastard tumor cells that might have been released. These suck. Chemo is always a race to kill cancer cells before the chemo drugs kill you. My oncologist is always checking white cell counts, but now has some DNA test that looks for tumor markers. This is pretty cool. My cell counts improve and the tumor market analysis looks good. So I'm eventually sent home. On my way out of my last meeting with my oncologist and his nurse, I ask him how often he gets to send someone home in my situation. The look in his eyes made it apparent how tough a job these folks have. So now 18 years later, I've been able to run a full marathon, finish my basement by myself, build the coolest shed in my back yard. Settle into a good IT career at a company where I can retire. And most importantly, be there when my kids graduated from school. Be there for my wife when her dad passed away from cancer. Just be there... So if a colonoscopy scares you, as they say in The Wire; ain't no thing. Don't be like Farrah Fawcett who died of anal cancer because she avoided treatment. 150K new cases of colorectal cancer are diagnosed annually in the US. And if discovered early, it can be treated far less invasively and less life-altering than if found later.
- bikenaga 3y ago- In assessing risks vs. benefits, it isn't sufficient to use a single figure (e.g. 5-year relative survival rate). It's not binary. Screening which detects potential cancer does not just prevent death. It prevents the suffering and disability which may accompany late-stage detection (even if you're still alive after 5 years). Early detection could have prevented the two surgeries and rounds of chemo a friend of mine went through. Or the death of another friend after 3 rounds of surgery and 2 rounds of chemo. It could prevent living the rest of your life without normal bowel function. Figures can't capture individual assessment of risk/benefit. Many of us buy insurance of various kinds even though the insurance companies have done some figures and expect to make money - in fact, they count on us valuing certain things above what is indicated by the raw numbers. - The NordICC study [0] is cited by some as showing modest benefits from colonoscopies. It looks pretty good, but there's something I don't understand. They say: "Follow-up data were available for 84,585 participants in Poland, Norway, and Sweden — 28,220 in the invited group, 11,843 of whom (42.0%) underwent screening, and 56,365 in the usual-care group. A total of 15 participants had major bleeding after polyp removal. No perforations or screening-related deaths occurred within 30 days after colonoscopy." Given the number of screenings, I don't see how there could be no perforations. For example, the USPTF study [1] (see their "Supporting evidence" link) reports 5.4 perforations per 10,000 colonoscopies from colonoscopy to follow-up positive screening results and 3.1 perforations per 10,000 colonoscopies from screening colonoscopy. No perforations seems unrealistically low - maybe someone can explain this. - Discomfort from the prep or procedure depend on the individual, and I don't think one can usefully generalize. I've had 4 colonoscopies, the first two with sedation and the last two without. I had 3 polyps removed the first time, none during the second, 2 polyps removed during the third, and none during the fourth. The advantages of no sedation are that I don't feel groggy afterward, and I can drive myself to and from. The procedures without sedation felt no worse than a bad case of gas (not surprisingly!). I watched the polyp removal during the third colonoscopy and didn't feel anything above the ambient gas pain. But some people might find the procedure very painful, or might get queasy watching. Everyone's different. And if you start without sedation and decide you want to stop in the middle, they might abandon the procedure and require you to come back again (in which case insurance is unlikely to pick up the second try). If you have one of these done with sedation, you might find it interesting to look at the itemized insurance docs and see how much they charged for the sedation (often done by an outfit independent from the GI practice). As for prep, the miralax with Gatorade is much better than the old stuff (which is damning with faint praise). [0] https://www.nejm.org/doi/full/10.1056/NEJMoa2208375 https://www.nejm.org/doi/full/10.1056/NEJMoa2208375 [1] https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening https://www.uspreventiveservicestaskforce.org/uspstf/recomme...
- elric 3y agoIt's interesting that the harm of the prep is not discussed. Not eating for one or two days and cleaning out your gut entirely with laxatives is bound to have consequences. Maybe this affects the gut microbiome? At the very least, this triggers days of migraine in myself. Just skipping one meal does that, skipping several and ingesting awful laxatives results in feeling awful for days. When you're dealing with such vast quantities of people, these effects might add up.
- ubermonkey 3y agoI was very, very worried about mine earlier this year. It was 100% a nonevent. My doc's prep regime was fairly mild (basically, a jug of gatorade with a whole jar of miralax in it at 6pm, and then another at 1am, for an 0800 call). I had no cramping or bloating to speak of. I didn't sleep in the bed with my wife after the 1am dose, mostly b/c I didn't want to disturb her by getting up over and over, but also slightly b/c I was a LITTLE afraid of not making it to the loo in time. This fear proved completely unfounded. The "worst" part for me really ended up being that I (wisely) did NOT go cycling on the Sunday before, since I know that ramps up my metabolism and leaves me very hungry the day after. I missed my ride, but it made the clear-diet Monday much more tolerable.
- nikolay 3y agoToday there are ColoFIT and Cologuard tests, which have high precision and are less invasive.